CHAMPS: Choices for Adolescent Methods of Prevention in South Africa

描述（由申请人提供）：在南非，年轻人在普通人群中感染艾滋病毒的发病率最高。青春期是一个复杂的过渡性发展阶段，与艾滋病毒感染有关的行为往往在这个阶段开始，很可能任何当前或未来的艾滋病毒预防战略都需要年轻人有效利用，才能在人口层面产生明显的影响。但是，尽管在年轻人中开展艾滋病毒预防工作很重要，但在南非和其他资源有限的环境中，很少有干预措施在减少这一群体感染艾滋病毒的风险方面显示出重大影响。该项目将通过一种新颖的方法，将不同的艾滋病毒预防战略结合成一份针对青少年的优化预防“菜单”，从而解决这一差距，面临艾滋病毒感染风险的年轻男女可以从中选择一种特定的战略组合，以满足他们的具体需求和情况。目前，有许多有希望和经过验证的预防干预措施，可能构成首选方案或组合的预防菜单，包括PrEP、杀微生物剂、艾滋病毒咨询和检测（HCT）以及包皮环切。在系统地审查了与这些和其他预防方法有关的文献后，将设计试点研究，以审查与青少年中这些预防方法有关的可行性、可接受性、依从性和性行为改变等关键问题。研究将尽可能模拟服务和试验的执行情况，以解决这些问题，包括与执行和执行有关的伦理-法律问题，以及考虑向青少年传递信息和社会推销这些办法。结果将用于流行病学建模和成本计算工作，以便告知应如何在年轻人中构建和推广这种预防“菜单”，以获得最大利益。这项研究将在一项单独提出的试验中达到高潮，该试验将检验“菜单”方法在预防南非青少年中新的艾滋病毒感染方面的功效。

DESCRIPTION (provided by applicant): In South Africa, young people have the highest incidence of HIV infection in the general population. Adolescence is a complex, transitional development phase when behaviors associated with HIV acquisition are often initiated, and it is likely that any current or future HIV prevention strategy will need to be effectively utilized by young people to have an appreciable population-level impact. But despite the importance of HIV prevention efforts among young people, there are few interventions that have demonstrated a significant impact in reducing risk of HIV infection among this group in South Africa and other resource-limited settings. This project will address this gap through a novel approach to combining different HIV prevention strategies into an optimized prevention 'menu' for adolescents, from which young women and men at risk of HIV infection may choose a particular combination of strategies to meet their specific needs and circumstances. Currently there are a number of promising and proven prevention interventions that could potentially constitute a prevention menu of preferred options or combinations, including PrEP, microbicides, HIV Counseling and Testing (HCT) and circumcision. After a systematic review of the literature relating to these and other prevention options, pilot studies will be designed in order to examine key issues of feasibility, acceptability, adherence and sexual behavior change associated with these prevention methods in adolescents. Studies will emulate implementation of services and trials as far as possible in order to address these questions, including ethico-legal issues associated with implementation and delivery, as well as consideration of messaging and social marketing of these approaches to adolescents. Results will be used to inform epidemiological modeling and costing exercises in order to inform how such a prevention 'menu' should be constructed and promoted among young people for maximum benefit. This research will culminate in a separately proposed trial to examine the efficacy of the 'menu' approach in preventing new HIV infections among South African adolescents.